Healthcare Provider Details

I. General information

NPI: 1407571003
Provider Name (Legal Business Name): LUKE JOSEPH CARRAWAY RN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2022
Last Update Date: 10/05/2022
Certification Date: 10/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 CHILDRENS AVE
OKLAHOMA CITY OK
73104-4637
US

IV. Provider business mailing address

2504 CAMRYNS XING
PANAMA CITY FL
32405-6651
US

V. Phone/Fax

Practice location:
  • Phone: 303-877-5191
  • Fax:
Mailing address:
  • Phone: 303-877-5191
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License NumberRN9543266
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: